Novel method of assessing surgical margin status in laparoscopic specimens

Objectives. To develop a novel method of inking laparoscopic specimens befo re piecemeal extraction to evaluate the surgical margins. Methods. Methylene blue, indigo carmine, and India ink were tested in vitro on cadaveric bovine kidneys before manual morcellation in laparoscopic ret rieval bags, and subsequently in pigs in vivo undergoing laparoscopic nephr ectomy. Tissue fragments were examined both grossly and microscopically aft er routine histologic processing. On the basis of the findings in these exp eriments, we used India ink clinically in 4 cases of laparoscopic nephrecto my and adrenalectomy for suspected tumor and assessed the ability to indica te specimen margins grossly and microscopically. Results. Methylene blue and India ink were the substances that best covered the surface of the surgical specimen completely, were best retained on the tissue, and were most easily washed from the retrieval bag. Gross inspecti on of the morcellated specimens easily distinguished the inked pieces, sign ifying tissue present at the surgical margin, from the uninked pieces. Duri ng morcellation, neither contamination of central tissue with ink nor leaka ge of ink from the bag occurred. India ink consistently endured fixation, e mbedding, and sectioning, with the black, inked margins of the specimen vis ible microscopically. Conclusions. Application of India ink before laparoscopic organ morcellatio n specifically marks the margins of the specimen. This technique allows pat hologic determination of the surgical margin status, as well as fractionati on of the tissue fragments, and addresses a criticism of organ morcellation . These improvements in the pathologic analysis of laparoscopically excised specimens may obviate the need for intact organ removal. (C) 2001, Elsevie r Science Inc.